In 55 patients with acute and in 34 with protracted pneumonia, the connection between dysfunctions of cholinergic and beta-adrenergic receptors of the bronchi (sensitivity and reactivity) was studied using inhaled samples with acetylcholine and obzidan and allergization of the body and bronchi at the stationary stage and during convalescence. To assess the state of allergization of the body and bronchi, the absolute number of eosinophils in the blood and allergic elements (eosinophils and Charcot-Leiden crystals) in sputum were studied. The results of the study did not reveal a correlation between allergies and impaired sensitivity and reactivity of the bronchi in patients with both acute and prolonged pneumonia.

As is known, in patients with pneumonia, along with signs of an infectious allergy, there may be a violation of the susceptibility (sensitivity and reactivity) of the bronchi, which play an important role in the development of bronchial obstruction, contributing to a protracted course and transition to chronic non-specific lung diseases [4, 5]. In this regard, questions of a correlation between allergies and impaired bronchial susceptibility in patients with pneumonia are of particular interest.

In this work, we examined the relationship between dysfunctions of the cholinergic and beta-adrenergic receptors of the bronchi (sensitivity and reactivity) and allergic status (allergization of the body and bronchi) in patients with various pneumonia both at the stationary stage and during convalescence.

Material and methods

To solve this problem, 79 patients with pneumonia were examined (men – 43, women – 36, average age – 36.0 +/- 4.1 years). Of these, 55 had an acute and 24 – a protracted course of the disease. Their allergic and hereditary history was not burdened. All patients underwent a generally accepted course of antibacterial, pathogenetic and symptomatic therapy.

The functional state of the cholinergic and beta-adrenergic receptors of the bronchi was studied using inhaled bronchial provocative samples with acetylcholine and obzidan according to the method of D.G. Chuchalina et al. Hypersensitivity (GH) of the bronchi was evaluated by the minimum (threshold) dose of the bronchoconstrictor, which caused a deterioration in bronchial patency (FEV1. FEV1 / ZHEL. PTMvyd) by 20% of the initial value, and hyperreactivity (GR) – by the value of the angle of the dose-response curve, reflecting the reaction of the bronchi to the introduction of a bronchoconstrictor in an increasing mode from the threshold dose (20% decrease.) to the maximum (35% decrease).

The state of the general allergic reactivity of the body was judged by the absolute number of eosinophils in the peripheral blood, which was studied according to the Piralishvili method, and the appearance of allergic elements (eosinophils and Charcot-Leiden crystals) in sputum was considered as a sign of emerging sensitization of the bronchopulmonary apparatus.

Results and discussion

Hypersensitivity of the bronchi was revealed in 29 (in 20 – to acetylcholine and in 9 – to obzidan) and increased reactivity – in 6 (5 – cholinergic and 1 – beta-adrenergic) of 55 patients with acute course. Of the 24 patients with a protracted course, 16 patients had MS (11 – cholinergic, 5 – beta-adrenergic) and 8 – GR bronchus (7 – cholinergic, 1 – beta-adrenergic).

In patients with both acute and prolonged pneumonia, eosinopenia was noted before treatment – 165.0 +/- 4.3 and 174.3 +/- 4.3, respectively, in 1 μl of blood (the absolute number of eosinophils in healthy individuals amounted to 180.0 +/- 5.5 in 1 μl of blood), but it was reliably expressed only in patients with acute course of the disease (p <0.05). After the treatment, the number of eosinophils in the blood in the group of patients with acute pneumonia tended to normalize to 183.2 +/- 5.5, and in the group of patients with prolonged course their number was significantly higher than the norm – 198.0 +/- 6, 9 (p <0.05).

Both in acute and in the protracted course of the disease, MS and GR of the bronchi were somewhat more often detected in patients who had an increased number of eosinophils in the blood (the absolute number of eosinophils at the end of treatment was compared with indicators of sensitivity and reactivity of the bronchi, since the number of eosinophils at the end of treatment in peripheral blood is reduced and does not reflect the true picture of allergies). So, the sensitivity of the bronchi was increased in patients with acute pneumonia in the presence of an increased number of eosinophils in 64.7% and with a protracted course of the disease in 76.9% of cases, respectively. An increase in bronchial reactivity was noted in 66.6% of cases with an acute course and in 62.5% of cases with a protracted course of pneumonia in the presence of an increased absolute number of blood eosinophils. However, the correlation coefficients between the degree of violation of the sensitivity and reactivity of the bronchi and the absolute number of eosinophils in the blood in both groups of patients were low (r = 0.11 and 0.12, respectively) and unreliable.

In patients with a protracted course of pneumonia, allergic elements in sputum were detected more often than in patients with an acute course of the disease. Sputum eosinophils with a prolonged course of the disease were detected in 6 (25.0%) of 24 patients. In 2 (8.3%), Charcot-Leiden crystals were determined in sputum. Significantly less often allergic elements were detected in the acute course of the disease – in 6 (10.9%) of 55 patients.

When comparing the sensitivity of the bronchi with the frequency of detection of allergic elements in sputum, it was found that in patients with bronchial allergization, violations of the sensitivity of the bronchi to acetylcholine are more often detected. In 6 (50.0%) of 12 patients, in the presence of allergic elements in sputum, increased sensitivity of bronchial cholinergic receptors was determined. Only in one case there was a violation of the function of beta-adrenergic receptors of the bronchi.

We investigated allergic indices, sensitivity and reactivity of the bronchi in parallel with pneumonia convalescents one month after discharge from the hospital (in comparative terms, depending on the nature of the course of the disease). Of the 14 convalescents who underwent pneumonia with HR bronchial tubes, an increase in the absolute number of eosinophils was noted in 2 (14.2%), and of the 15 convalescents who underwent protracted pneumonia, the absolute number of eosinophils was increased in 5 (33.3%). Of 10 convalescents who had an acute course of pneumonia with bronchial GR, an increased number of eosinophils after a month was detected in 3 (30%), and of 12 convalescents with a protracted course of pneumonia, in 5 (41.6%). The correlation coefficients in these groups were also unreliable (r = 0.08 and 0.1, respectively).

Summing up the study, it can be noted that patients with pneumonia (both acute and prolonged) often have violations of the local autonomic mechanisms that regulate the tone of the muscles of the bronchi, which, in turn, contributes to the development of bronchial obstruction, which underlies the protracted course and its chronicity. In patients with a prolonged course of pneumonia during the period of clinical recovery, against the background of generally accepted antibacterial therapy, a statistically significant increase in the absolute number of eosinophils in the blood is noted. However, in patients with pneumonia there is no correlation between the severity of allergies and impaired susceptibility (sensitivity and reactivity) of the bronchi, both at the stationary stage and during convalescence. The absence of a significant part of the examined patients between the bronchial hypersensitivity (GH and GR) and allergies can be explained by the well-known position in the literature that bronchial susceptibility and immunological GH of the immediate type are controlled by various groups of genes.